The delivery nurse is reporting to the postpartum nurse abou...

The client had a D&C for treating an incomplete spontaneous abortion. Which statements should the nurse include when preparing the client for discharge the same day? Select all that apply.

A. “Return for a blood transfusion if bleeding continues to be dark red.”
B. “Intravenous antibiotics will be prescribed every 8 hours for two days.”
C. “I can make a referral to a pregnancy loss support group if you like.”
D. “You need to use contraceptives to avoid getting pregnant for one year.”
E. “Someone should remain with you at home for the first 12 to 24 hours.”

Correct Answer: C,E

Rationale: The client who had an incomplete spontaneous abortion may experience grief and loss. The nurse should offer to do a referral to a pregnancy loss support group to provide ongoing support after hospital discharge. A D&C is usually performed on an outpatient basis if there are no complications, and the client can return home a few hours after the procedure. Someone should remain with the client to ensure that she is safe and no complications develop. Dark red blood does not necessarily indicate the need for a blood transfusion; it could be old blood. The client should notify the HCP if experiencing heavy bleeding following the D&C. A D&C for treating incomplete spontaneous abortion does not require the routine administration of IV antibiotics. There is no medical need for the client who had a spontaneous abortion to avoid pregnancy for one year.

While assessing the breastfeeding mother 24 hours postdelivery, the nurse notes that the client’s breasts are hard and painful. Which interventions should be implemented by the nurse? Select all that apply.

A. Tell her to feed a small amount from both breasts at each feeding.
B. Apply ice packs to the breasts at intervals between feedings.
C. Give supplemental formula at least once in a 24-hour period.
D. Administer an anti-inflammatory medication prescribed pm.
E. Apply warm, moist packs to the breasts between feedings.
F. Pump the breasts as needed to ensure complete emptying.

Correct Answer: B,D,F

Rationale: Moving the baby from the initial breast to the second breast during the feeding, before the initial breast is completely emptied, may result in neither breast being totally emptied and thus promote continued engorgement. Because engorgement is caused, in part, by swelling of the breast tissue surrounding the milk gland ducts, applying ice at intervals between feedings will help to decrease this swelling. Giving supplemental formula, thus limiting the time the baby nurses at the breast, prevents total emptying of the breast and promotes increased engorgement. Administering anti-inflammatory medication will decrease breast pain and inflammation. Because heat application increases blood flow, moist heat packs would exacerbate the engorgement. Pumping the breasts may be necessary if the infant is unable to completely empty both breasts at each feeding. Pumping at this time will not cause a problematic increase in breast milk production.

The laboring multigravida client’s last vaginal examination was 8/90/+1. The client now states feeling rectal pressure. Which action should the nurse perform first?

A. Encourage the client to push.
B. Notify the obstetrician or midwife.
C. Help the client to the bathroom.
D. Complete another vaginal exam.

Correct Answer: D

Rationale: The nurse should first evaluate labor progress by performing another vaginal exam. Previously the client was almost fully effaced (90%), and fetal station was 1 cm below the ischial spines (+1). Rectal pressure is often due to pressure exerted during descent of the fetal presenting part. The client needs to be fully dilated (10 cm, not 8 cm) and fully effaced (100%, not 90%) before being encouraged to push. Pushing too early may cause cervical edema and lacerations and may slow the labor process. Rectal pressure may indicate that the client has progressed since the last vaginal exam. Another vaginal exam should be performed before contacting the obstetrician or midwife. During labor, rectal pressure is usually not due to the need for a bowel movement because intestinal motility decreases.

The nurse responds that, for clients with uncomplicated pregnancies, it is usually best to plan monthly visits for the first 28 weeks and then more frequent visits following which schedule?

A. Weekly for the remainder of the pregnancy
B. Every 2 weeks for the remainder of the pregnancy
C. Every 2 weeks up to 36 weeks, then weekly for the last month
D. Weekly up to 36 weeks, then twice weekly for the last month

Correct Answer: C

Rationale: Standard prenatal care involves monthly visits until 28 weeks, biweekly until 36 weeks, and weekly thereafter for uncomplicated pregnancies.

The nurse educates the breastfeeding client diagnosed with mastitis. The nurse evaluates that the client has an adequate understanding of how to prevent mastitis in the future when the client makes which statements? Select all that apply.

A. “Incorrect latch of my baby can lead to mastitis.”
B. “I should perform hand hygiene before I breastfeed.”
C. “I should rinse my baby’s mouth before I let her latch.”
D. “A tight underwire bra has support that prevents mastitis.”
E. “I should allow my nipples to air-dry after breastfeeding.”

Correct Answer: A,B,E

Rationale: Incorrect latch can cause nipple tissue to blister, crack, and bleed. These breaks in the tissue may serve as an entry point for pathogens. Hand hygiene prior to breastfeeding reduces the number of pathogens available for invasion. While the infant’s nose and throat are sources of pathogenic organisms that might cause mastitis, washing the infant’s mouth would be difficult and would not provide adequate protection for the mother. Wearing a tight bra, especially with an underwire, may restrict milk ducts, providing milk stasis and a medium for pathogenic growth. Allowing breasts to air-dry helps to reduce skin breakdown that might be caused by a moist, wet environment.

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Correct Answer: 1